Thesis (Ph. D.)--University of Virginia, 1997. / Includes bibliographical references (105-117). Also available online through Digital Dissertations.

Thesis (M. P. H.)--University of Hong Kong, 2006. / Also available in print.

Thesis (M.P.H.)--University of Hong Kong, 2006.

Disputes between patients and providers regarding life-sustaining medical treatment (LSMT) are universal across all U.S. states, yet policies regarding these disputes differ significantly. This dissertation determines that all 50 states have advance directive laws that protect a patient’s right to refuse LSMT even when a healthcare provider objects, yet only some states have policies that protect the patient’s right to choose to continue LSMT when a healthcare provider objects (a dispute known as medical futility). Some states have pro-patient laws that protect the patient’s right to make the final decision, while other states have enacted pro-provider medical futility policies that explicitly grant the provider authority to remove LSMT against the patient’s wishes. Finally, in one state, the law delegates the final decision to a third-party: institutional healthcare ethics committees. This dissertation studies the innovation and adoption of these 17 state medical futility policies, examining the theory that values determine both whether the state adopts a medical futility policy as well as what type of medical futility policy a state will adopt- as the policy actors that represent these values: policy entrepreneurs and interest groups. A comparative case study of successful third-party policy adoption in Texas contrasted against a failed effort in Idaho could not affirm the necessity of policy entrepreneurs for policy adoption but did affirm the necessity of interest group consensus and the role of values. Furthermore, quantitative analysis failed to offer statistically-significant evidence of value indicators, but did suggest that government ideology and political party affiliation may potentially become indicators of the type of medical futility policy that states choose to adopt.

Advance directives (ADs) convey consumers' wishes about accepting or refusing future treatment if they become incompetent. The issue of making a particular AD, more commonly referred to as a living will, is the focus of this thesis. The typical direction of the living will is that life-sustaining activities such as the provision of mechanical ventilation should be withheld so that a person may die what is hoped to be a 'peaceful death'. Clearly the whole basis of the thinking behind the recognition of ADs is that patients' wishes should prevail. ADs have been championed by some as a means of preserving both dignity and autonomy at the end of life in the face of increasing medical advances in technology to preserve life indefinitely. ADs are seen as a means of promoting peace of mind in will-makers, of allowing carers and family to honour the person's wishes and of stimulating communication between all involved parties.While at present there is no statutory right for people in New Zealand to make ADs, it is considered they have rights to do so in common law as consumers of health and disability services in this country. Little is known about the views of New Zealanders making ADs or their justification for doing so. This small qualitative study, using a discourse analysis approach after Potter and Wetherell (1987), aimed to investigate how the participants justified making ADs. Six people were interviewed and the transcriptions were analysed identifying three dominant interpretative repertoires and three corresponding subject positions.The findings indicated that the participants positioned themselves: as independent self-determining individuals who knew when they were ready to make ADs after witnessing undesirable deaths of close family members; as judges of knowing when inappropriate treatments lead to undignified deaths; and as concerned parents who want to relieve their families of uncertainty in the future when making surrogate end-of-life decisions for them. Witnessing a prolonged family member's death in the past was a contributing factor to the participants making ADs. The participants' recall of these events led them to make their wishes known in advance so that their families, in turn, would not have to go through a similar experience at the terminal stages of their lives. The overarching motivations for formalising ADs was to avoid having life artificially prolonged by receiving life-sustaining treatments as well as the desire to die a dignified death.This study highlights the need for healthcare professionals to value the importance of advance planning with well adults before they lose the capacity to give informed choices at the end of life. The taking of a values history as part of this advance planning may inform family and healthcare professionals about peoples' general values and at the same time confirm and record end-of-life choices for future reference.

Advance directives (ADs) convey consumers' wishes about accepting or refusing future treatment if they become incompetent. The issue of making a particular AD, more commonly referred to as a living will, is the focus of this thesis. The typical direction of the living will is that life-sustaining activities such as the provision of mechanical ventilation should be withheld so that a person may die what is hoped to be a 'peaceful death'. Clearly the whole basis of the thinking behind the recognition of ADs is that patients' wishes should prevail. ADs have been championed by some as a means of preserving both dignity and autonomy at the end of life in the face of increasing medical advances in technology to preserve life indefinitely. ADs are seen as a means of promoting peace of mind in will-makers, of allowing carers and family to honour the person's wishes and of stimulating communication between all involved parties.While at present there is no statutory right for people in New Zealand to make ADs, it is considered they have rights to do so in common law as consumers of health and disability services in this country. Little is known about the views of New Zealanders making ADs or their justification for doing so. This small qualitative study, using a discourse analysis approach after Potter and Wetherell (1987), aimed to investigate how the participants justified making ADs. Six people were interviewed and the transcriptions were analysed identifying three dominant interpretative repertoires and three corresponding subject positions.The findings indicated that the participants positioned themselves: as independent self-determining individuals who knew when they were ready to make ADs after witnessing undesirable deaths of close family members; as judges of knowing when inappropriate treatments lead to undignified deaths; and as concerned parents who want to relieve their families of uncertainty in the future when making surrogate end-of-life decisions for them. Witnessing a prolonged family member's death in the past was a contributing factor to the participants making ADs. The participants' recall of these events led them to make their wishes known in advance so that their families, in turn, would not have to go through a similar experience at the terminal stages of their lives. The overarching motivations for formalising ADs was to avoid having life artificially prolonged by receiving life-sustaining treatments as well as the desire to die a dignified death.This study highlights the need for healthcare professionals to value the importance of advance planning with well adults before they lose the capacity to give informed choices at the end of life. The taking of a values history as part of this advance planning may inform family and healthcare professionals about peoples' general values and at the same time confirm and record end-of-life choices for future reference.

Thesis (M.S.)--University of Wisconsin--Madison, 1990. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 157-161).

Thesis (M.Nurs.)--Washington State University, August 2007. / Includes bibliographical references (p. 40-48).

Thesis (M. Nurs.)--University of Hong Kong, 2006.

Purpose: The purpose of this project is to decrease the likelihood of receiving unwanted treatment at the end of life. The project is conducted in a skilled nursing facility where only approximately 40% of the residents have an Advance Directive (AD) despite experiencing multiple comorbidities and nearing the end of life. Aims: Implementing a quality improvement project, creating a system that addresses AD completion at admission with the outcome of increased recognition of residents’ end of life choices. Process: Residents and their families are presented with a tool to help guide the conversation about AD at the admission care plan meeting. AD will be readdressed at all subsequent care plan meetings, occurring every 45 days, and as needed. Results: Project is still in process and the expected completion date is April 8th, 2022. We anticipate improvement in AD completion rates in this facility. Limitations: This project is limited by the reluctance of some residents and families to discuss issues related to death and dying, which may affect the completion rate. Another limiting factor is the staff turnover and need to reeducate new staff members about the project. Conclusions: Residents in skilled nursing facilities are likely to receive unwanted treatment because families are unsure what their wishes and are left feeling obligated to do everything necessary to sustain life. The implementation of this project may increase the AD completion rates, while recognizing and carrying out residents’ end of life choices.